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Cognitive Outcome in Childhood-Onset Epilepsy: A Five-Decade Prospective Cohort Study

Published online by Cambridge University Press:  10 January 2017

Mira Karrasch ,
Petri Tiitta ,
Bruce Hermann ,
Juho Joutsa ,
Shlomo Shinnar ,
Juha Rinne ,
Anu Anttinen  and
Matti Sillanpää
Mira Karrasch*
Affiliation:
Department of Psychology, Åbo Akademi University, Turku, Finland
Petri Tiitta
Affiliation:
Department of Public Health, University of Turku, Finland Turku Teacher Training College, University of Turku, Finland
Bruce Hermann
Affiliation:
Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Juho Joutsa
Affiliation:
Turku PET Centre, University of Turku and Turku University Hospital, Finland Department of Clinical Neurophysiology, University of Turku and Turku University Hospital, Finland Departments of Neurology, Pediatrics and Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York
Shlomo Shinnar
Affiliation:
Division of Clinical Neurosciences, University of Turku and Turku University Hospital, Finland
Juha Rinne
Affiliation:
Turku PET Centre, University of Turku and Turku University Hospital, Finland Department of Clinical Neurophysiology, University of Turku and Turku University Hospital, Finland
Anu Anttinen
Affiliation:
Department of Clinical Neurophysiology, University of Turku and Turku University Hospital, Finland
Matti Sillanpää
Affiliation:
Departments of Public Health and Child Neurology, University of Turku, Finland
*
Correspondence and reprint requests to: Mira Karrasch, Department of Psychology, Abo Akademi University, FIN-20500 Turku, Finland. E-mail: [email protected].
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Abstract

Objectives: Little is known about the very long-term cognitive outcome in patients with childhood-onset epilepsy. The aim of this unique prospective population-based cohort study was to examine cognitive outcomes in aging participants with childhood-onset epilepsy (mean onset age=5.3 years) five decades later (mean age at follow-up=56.5 years).Methods: The sample consisted of 48 participants with childhood-onset epilepsy and 48 age-matched healthy controls aged 48–63 years. Thirty-six epilepsy participants were in remission and 12 continued to have seizures. Cognitive function was examined with 11 neuropsychological tests measuring language and semantic function, episodic memory, and learning, visuomotor function, executive function, and working memory. Results: The risk of cognitive impairment was very high in participants with continuing seizures; odds ratio (OR)=11.7 (95% confidence interval [CI] (2.8, 49.6), p=.0008). They exhibited worse performances across measures of language and semantic function, and visuomotor function compared to participants with remitted epilepsy and healthy controls. In the participants with remitted epilepsy, the risk of cognitive impairment was somewhat elevated, but not statistically significant; OR=2.6 (95% CI [0.9, 7.5], p=.08).Conclusions: Our results showed that the distinction of continued versus discontinued seizures was critical for determining long-term cognitive outcome in childhood-onset epilepsy. Few participants in remission exhibited marked cognitive impairment compared to age-matched peers. However, a subgroup of participants with decades long active epilepsy, continuous seizure activity and anti-epileptic drug (AED) medication, showed clinically significant cognitive impairment and are thus in a more precarious position when entering older age. (JINS, 2017, 23, 332–340)

Keywords

AgingLanguageNeuropsychologySeizureSemantic functionVisuomotor function
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 23 , Issue 4 , April 2017 , pp. 332 - 340
Copyright
Copyright © The International Neuropsychological Society 2017 

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